Picture this. In the first months after your husband's stroke, every week brought something new: a finger that moved, a word that came back, the first steps with a walking frame. Now the therapy sessions are fewer, the gains are smaller, and someone has used the word "plateau". You sit in the car outside the rehabilitation centre and wonder if this is as good as it will get.
What happens in a stroke or brain injury
A stroke happens when the blood supply to part of the brain is cut off by a clot, or when a blood vessel bursts. A traumatic brain injury, or TBI, is damage caused by an outside force, such as a car accident, a fall or an assault. In both cases, brain cells in the affected area are injured or lost.
What a person struggles with afterwards depends on which areas were affected. It may be movement on one side, speech and understanding, memory, attention, vision, mood or personality.
Stroke is an emergency: know the signs
Before anything else, this needs saying clearly. A stroke is a medical emergency and every minute counts. Neurofeedback has no role at this stage. Remember the word FAST:
- Face: one side of the face droops when the person smiles
- Arms: one arm drifts down or cannot be lifted
- Speech: words are slurred, jumbled or will not come
- Time: call emergency services immediately.
Other warning signs include sudden loss of vision, sudden severe headache, sudden dizziness or confusion, and numbness on one side. After a head injury, go to an emergency unit for worsening headache, repeated vomiting, a seizure, increasing drowsiness or confusion. Someone who has already had a stroke should treat any new symptom of this kind as an emergency too.
Neuroplasticity, and why rehabilitation comes first
Neuroplasticity is the brain's ability to change its own wiring in response to practice and experience. Brain cells that are lost do not grow back in any meaningful way. But the surviving areas can form new connections and, to some extent, take over or support functions that were disrupted.
This rewiring is driven by repetition. It is the reason physiotherapists ask for the same movement again and again, and speech therapists drill the same sounds. Each repetition tells the brain that this pathway matters.
Recovery is usually fastest in the first few months, when the brain is especially responsive. After that, progress tends to slow. Slower does not mean finished. People can continue to make gains long afterwards with regular, meaningful practice, although the pace and the ceiling differ for everyone.
A plateau is not always the end of recovery. Sometimes it is the brain asking for a different kind of practice.
The backbone of recovery is medical care and formal rehabilitation. That means your neurologist or physician, and a team that may include physiotherapy, occupational therapy, speech therapy and psychology. Medication to prevent another stroke or to control seizures must be taken exactly as prescribed.
Neurofeedback is complementary to all of this. It cannot replace therapy, and it should only begin once the person is medically stable and the treating doctor is aware of it.
Where neurofeedback may fit
Neurofeedback is a non-invasive form of brain training. Small sensors on the scalp read the brain's electrical activity. Nothing is sent into the brain. When the brain shifts towards a steadier pattern, the person receives feedback through a sound or a picture on a screen. The aim is that, with repetition, the brain learns the rewarded pattern. Our plain guide to what neurofeedback is explains the basics.
It is important to be honest about what this can do. Neurofeedback does not repair damaged brain tissue or bring back lost cells. It aims to offer the working parts of the brain another form of guided practice in regulating themselves.
After a brain injury, the difficulties that often limit daily life and therapy are not only physical. They include poor attention, mental fatigue, disturbed sleep, a short temper and low mood. These are the areas that neurofeedback training usually aims at, although the evidence after stroke and brain injury is still limited. A person who sleeps better and can concentrate for longer may be able to get more from their physiotherapy and speech therapy sessions.
Researchers are also studying neurofeedback for movement and speech recovery after stroke. That work is still at an early stage, and nobody can promise a return of a specific function. Results vary widely, depending on the injury, the time that has passed and the person's general health.
How training works at our practice
Every client at our Krugersdorp practice starts with a 19-channel brain map, which takes about an hour and a half. It is a recording of how the brain is functioning at the time.
Sessions last 45 to 60 minutes and begin with a short check-in. Seizures are more common after a brain injury, so mention any seizure history to your doctor and to any neurofeedback practitioner before starting. Our what to expect page describes each step.
For milder head injuries, see our article on post-concussion syndrome.
Common questions
Can neurofeedback repair the brain after a stroke?
No. Neurofeedback does not repair damaged tissue or replace lost brain cells. It is a complementary form of training that aims to give the working parts of the brain guided practice in regulating themselves. The hope is to support attention, fatigue, sleep and mood, which may in turn support rehabilitation. Evidence is limited and results vary.
Is it too late if the injury happened years ago?
Not necessarily. The brain keeps its ability to learn throughout life, though change is usually slower long after an injury. Nobody can promise improvement. Talk to the treating doctor, and ask your questions, before deciding whether it is worth trying.
Is neurofeedback safe for someone who has seizures?
The sensors only read brain activity and send nothing into the brain. Even so, anyone with seizures after a brain injury should speak to their neurologist first and must keep taking their anti-seizure medication exactly as prescribed. Mention any seizure history to your doctor and to any neurofeedback practitioner before starting.
Caring for someone after a stroke or brain injury is a long road, and carers get tired too. If the medical team is in place and you would like to know whether brain training could add something to the rehabilitation plan, you are welcome to speak to Irine.
- stroke
- tbi
- neurorehabilitation
- speech recovery
- motor recovery
